老年2型糖尿病患者血清sCXCL16水平与糖尿病肾病进展及预后的关联性研究

A study on the relationship between serum sCXCL16 level and the progression and prognosis of diabetic kidney disease in elderly patients with type 2 diabetes mellitus

目的 探讨老年2型糖尿病(T2DM)患者血清可溶性CXC趋化因子配体16(sCXCL16)水平与糖尿病肾病(DKD)进展及预后的关联性。方法 招募2017年4月至2020年1月清华大学附属垂杨柳医院收治的55例DKD患者(DKD组)和54例单纯T2DM患者(T2DM组)为研究对象,另选择55名体检健康者作为对照组。比较三组血清sCXCL16水平,并分析其与DKD进展及预后的关联性。结果 DKD组和T2DM组血清sCXCL16水平均高于对照组,且DKD组血清sCXCL16水平高于T2DM组,差异有统计学意义(P<0.05)。对于DKD患者,大量白蛋白尿亚组血清sCXCL16水平显著高于微量白蛋白尿亚组(P<0.05)。Spearman秩相关分析结果显示,血清sCXCL16水平与尿素氮(BUN)、肌酐(Cr)、尿白蛋白排泄(UAE)、评估稳态模型-胰岛素抵抗指数(HOMA-IR)、24 h蛋白尿、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)均呈正相关(P<0.05)。多因素logistic回归分析结果显示,血清sCXCL16>18.50 ng/ml是促进老年T2DM患者DKD发生的独立危险因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,血清sCXCL16水平能有效鉴别T2DM和DKD[AUC(95%CI)=0.866(0.801~0.931),P<0.001],并能有效预测DKD患者发生终末期肾脏病(ESRD)[AUC(95%CI)=0.854(0.747~0.962),P<0.001]。多因素Cox回归分析结果显示,血清sCXCL16水平≥20.02 ng/ml是促进DKD患者发生ESRD的独立危险因素(P<0.05)。结论 老年T2DM患者血清sCXCL16水平升高与DKD的发生、发展密切相关,其水平监测有助于临床医师评估患者病情。

Objective To investigate the relationship between serum soluble CXC chemokine ligand 16(sCXCL16)level and the progression and prognosis of diabetic kidney disease(DKD)in elderly patients with type 2 diabetes mellitus(T2DM).Methods Fifty-five patients with DKD(DKD group)and 54 patients with simple T2DM(T2DM group)who were admitted to Chuiyangliu Hospital Affiliated to Tsinghua University from April 2017 to January 2020 were recruited as the study subjects,and 55 healthy subjects undergoing physical examination were selected as the control group.Serum sCXCL16 level was compared among the three groups,and the relationship of the serum sCXCL16 level with DKD progression and prognosis was analyzed.Results The serum sCXCL16 level in the DKD group and the T2DM group was higher than that in the control group,and the serum sCXCL16 level in the DKD group was higher than that in the T2DM group,and the differences were statistically significant(P<0.05).For the DKD patients,the serum sCXCL16 level in the macroalbuminuria subgroup was higher than that in the microalbuminuria subgroup(P<0.05).The results of Spearman rank correlation analysis showed that serum sCXCL16 level was positively correlated blood urea nitrogen(BUN),creatinine(Cr)and urinary albumin excretion(UAE),homeostasis model assessment of insulin resistance(HOMA-IR),24-hour proteinuria,tumor necrosis factor-α(TNF-α)and hypersensitive C-reactive protein(hs-CRP)(P<0.05).The results of multivariate logistic regression analysis showed that serum sCXCL16>18.50 ng/ml was an independent risk factor for DKD in elderly T2DM patients(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that serum sCXCL16 level could effectively differentiate T2DM from DKD[AUC(95%CI)=0.866(0.801-0.931),P<0.001],and could effectively predict end-stage renal disease(ESRD)in the DKD patients[AUC(95%CI)=0.854(0.747-0.962),P<0.001].The results of multivariate Cox regression analysis showed that serum sCXCL16 level≥20.02 ng/ml was an independent risk factor for ESRD in the DKD patients(P<0.05).Conclusion Elevated serum sCXCL16 level in elderly T2DM patients is closely related to the occurrence and development of DKD,and the monitoring of serum sCXCL16 level is helpful for clinicians to evaluate the patients′condition.